MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Former chiropractor Malcolm Hooper, 61, and hyperbaric oxygen therapy provider Oxymed Pty Ltd have been fined following the death of a customer in 2016. They were each convicted of three work safety-related charges, all of failing to ensure a workplace is safe and without risks to health. Hooper was fined $176,750, while the company was fined $550,000. Oxymed was trading as HyperMed at its South Yarra premises in April 2016 when a long-term client with multiple sclerosis and a history of life-threatening seizures came in for treatment. He was later found unconscious in a single-person hyperbaric chamber, taken to hospital, and placed on life support, but died five days later.

The County Court heard that both the company and Hooper had an inadequate system in place for assessing the risks oxygen therapy could pose to clients, and an inadequate system too for developing plans to eliminate or reduce those risks. In her judgment, County Court judge Amanda Fox said HyperMed wasn’t a hospital nor a medical practice and had been described as an “alternative health facility”. Hooper had already been deregistered in 2013 by the national board for chiropractors for misleading and deceptive advertising about the benefits of hyperbaric treatment.

Hyperbaric oxygen therapy involves administering pure oxygen in a pressurised environment, with the heightened air pressure allowing a patients’ lungs to gather much more oxygen than would be possible under normal conditions. The therapy is not based on strong data. A systematic review failed to find good evidence for hyperbaric oxygen therapy as a treatment of multiple sclerosis:

Multiple sclerosis (MS) is a chronic, inflammatory, and degenerative neurological illness with no cure. It has been suggested that Hyperbaric Oxygen Therapy (HBO(2)T) may slow or reverse the progress of the disease. This article summarizes the clinical evidence for the use of HBO(2)T in the treatment of MS. We conducted a literature review focused on the interaction of hyperbaric oxygenation and MS. In particular, we appraised the clinical data regarding treatment and performed a meta-analysis of the randomized evidence using the methodology of the Cochrane Collaboration. We found 12 randomized studies in the area, all of which were performed between 1983 and 1987. A meta-analysis of this evidence suggests there is no clinically significant benefit from the administration of HBO(2)T. The great majority of randomized trials investigated a course of 20 treatments at pressures between 1.75ATA and 2.5ATA daily for 60-120 min over 4 weeks against a placebo regimen. None have tested the efficacy of HBO(2)T against alternative current best practice. No plausible benefit of HBO(2)T on the clinical course of MS was identified in this review. It remains possible that HBO(2)T is effective in a subgroup of individuals not clearly identified in the trials to date, but any benefit is unlikely to be of great clinical significance. There is some case for further human trials in selected subgroups and for prolonged courses of HBO(2)T at modest pressures, but the case is not strong. At this time, the routine treatment of MS with HBO(2)T is not recommended.

The case reminds me of that of John Lawler. Mr. Lawlwer’s chiropractor also used a therapy that was not indicated, broke his neck (to put it crudely), and subsequently proved herself more than inept in saving his life. It suggests to me that some chiros may not be trained adequately to deal with emergencies. If that is true, they should perhaps focus less on practice-building courses and more on first aid instructions.

2 Responses to Former chiropractor fined after death of MS patient receiving hyperbaric oxygen therapy

  • Hyperbaric oxygen therapy has been in demand for treating MS for a long time, with very little evidence to support its use. Unfortunately it is the nature of the disease that it remits and relapses, and as people generally seek new treatment when they are at their worst this is usually followed by an improvement more-or-less whatever they do. This makes MS sufferers particularly easy to convince that some dodgy treatment or other has worked, and there are all kinds of campaigns for useless therapies to be made available on the NHS.

    Hyperbaric oxygen therapy has its place in treating other conditions, inlcuding possibly long-term radiation damage. And of course it is standard emergency treatment for decompression sickness in divers.

    I have done a lot of scuba diving myself, and used to do the medicals for my local club. As a result I am well aware of the pharmacological effects that gases can have and how this changes with the inspired pressure. In particular, oxygen can be toxic and high pressures, and above a partial pressure of 1.6 atmospheres it is well-known to trigger epileptic fits, even in individuals without epilepsy. This is equivalent to breathing air at a depth of 70 metres, which no diver would ever do deliberately as they would be unconscious from nitrogen narcosis by then. It is also equivalent to breathing pure oxygen at a depth of 6 metres; normally scuba divers don’t have pure oxygen in their tanks but some very experienced divers using mixed gases sometimes breathe pure oxygen near the surface in order to speed up nitrogen loss from their tissues.

    Anybody operating a hyperbaric oxygen chamber should be well aware of the risk of epileptic fits, and a history of epilepsy would be considered a contraindication to treatment. If there are situations where it might be used, at the very least I would expect there to be a resuscitation team, including an anaesthetist, standing by. Given the circumstances I am surprised that Hooper isn’t facing a manslaughter charge.

    • Likewise – I’m astonished the practitioner isn’t charged with manslaughter or at least the organisation behind the practice isn’t up on a charge of corporate manslaughter. Maybe it’s a US thing.

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